Wisconsin Attorney General Josh Kaul announced on Thursday, November 5, 2026, that the Wisconsin Department of Justice has filed criminal charges against a Milwaukee woman accused of submitting more than $1 million in fraudulent claims to the Wisconsin Medicaid program through her agency, Abby's Clubhouse, according to the Department of Justice release republished by WisPolitics and the U.S. Department of Health and Human Services Office of Inspector General.

The defendant is Caprice Mathies-Hill, 53, of Milwaukee. Of the more than $1 million in claims the complaint alleges she submitted, she was allegedly paid more than $470,000 to which she was not entitled, the Justice Department said. The charges are accusations only: Mathies-Hill is presumed innocent unless and until she is proven guilty.

The four counts

Mathies-Hill is charged in Milwaukee County Circuit Court with one count of theft by fraud, one count of public assistance fraud (offering a kickback), one count of public assistance fraud, as a party to the crime (providing a kickback), and one count of wire fraud, as a party to the crime, according to the criminal complaint described in the Justice Department release.

$1M+Medicaid claims the complaint alleges were submitted
$470,000+amount allegedly paid out to which she was not entitled
4counts filed in Milwaukee County Circuit Court
Nov. 2020–Oct. 2023period the complaint says the claims covered

What the complaint alleges

According to the criminal complaint, Mathies-Hill, through her agency Abby's Clubhouse, allegedly defrauded the state Medicaid program by submitting prenatal care coordination (PNCC) and childcare coordination (CCC) claims for services that were never provided. Abby's Clubhouse submitted PNCC or CCC claims for services from about November 2020 to October 2023, the department said.

The complaint also outlines an alleged recruitment method: Mathies-Hill allegedly enrolled members into Abby's Clubhouse by offering them items not covered by Medicaid, such as diapers or baby wipes, and then submitted reimbursement claims connected to those non-eligible goods, according to reporting on the complaint by WISN. That account, like the rest of the complaint, is an allegation that has not been tested in court.

What PNCC is meant to do

Prenatal care coordination programs are referral-based services designed to connect at-risk pregnant women with medical, social and educational services to improve birth outcomes. Childcare coordination serves a similar connecting role for families with young children. Billing such programs for services never provided takes money meant for mothers and children, which is why state fraud units treat these cases seriously.

How the case reached prosecutors

The case was referred to the Wisconsin Department of Justice by the Wisconsin Department of Health Services – Office of the Inspector General, the state office that audits Medicaid providers. The investigation was led by the Wisconsin DOJ's Medicaid Fraud Control and Elder Abuse Unit, and the Justice Department is prosecuting the case, Attorney General Kaul's office said.

Not the first PNCC case in Wisconsin

The Abby's Clubhouse charges land in a state that has already seen a series of similar prenatal-care billing prosecutions. In June 2026, the U.S. Attorney's Office for the Eastern District of Wisconsin announced a federal charge against Jasmine Cooper of Brown Deer, whose agency allegedly submitted more than $5.8 million in false PNCC and CCC claims and was paid more than $5.4 million. Federal prosecutors said that case came on the heels of four similar schemes, and that together they had cost Wisconsin Medicaid more than $15.5 million between 2019 and 2022. The Mathies-Hill case is a separate state prosecution, brought by the Wisconsin DOJ rather than federal prosecutors.

Medicaid is the public health coverage program for low-income residents, including many working families and new immigrants in cities such as Milwaukee. Money paid out on claims for services that were never provided is money taken out of that shared system, and state officials say recovering it — and deterring the next scheme — is the point of specialised fraud-control units like the one that investigated this case.

What happens next

The case will now proceed in Milwaukee County Circuit Court, where Mathies-Hill will answer the four counts. The Justice Department release did not announce a first court date. If convicted, the sentence will be set by the court under Wisconsin law; no plea has been reported, and the defendant remains presumed innocent.